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The combative multitrauma patient: a protocol for prehospital management.
Eitan Melamed1, Yahav Oron, Ron Ben-Avraham
1IDF Trauma Branch, Surgeon General Headquarters, IDF Medical Corps, Israel. eitanme2000@yahoo.com
Summary
Prehospital management of combative trauma patients can be effectively achieved using ketamine, alone or with midazolam. This approach demonstrated successful sedation without adverse effects in a case series, suggesting a viable protocol.
Area of Science:
- Emergency Medicine
- Prehospital Care
- Trauma Management
Background:
- Combative behavior in trauma patients presents significant challenges in prehospital settings.
- Delayed definitive care in certain environments necessitates effective on-site management strategies.
Purpose of the Study:
- To describe the prehospital management of combative trauma patients.
- To propose a management protocol for these challenging cases.
Main Methods:
- Retrospective case series of 11 patients experiencing combativeness post-trauma.
- Data collected from military medical teams over a 2-year period.
- Expert panel convened to develop a management protocol.
Main Results:
- Ketamine was administered intravenously to five patients, with three receiving it alongside midazolam.
- Sedation was effective in all five cases, with no reported increase in agitation or adverse effects.
- Patients experienced a mean delay of 114 minutes to definitive care.
Conclusions:
- An algorithmic approach utilizing ketamine as the primary sedative is outlined.
- Ketamine, alone or combined with midazolam, is suggested for effective sedation of agitated prehospital trauma patients.
- The combination of ketamine and midazolam is recommended for adult prehospital combative populations.
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